Adjudicator, Provider Claims (On the Phones, Must reputed company in OH)

Job reputed company Job reputed company The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate reputed company of claims issues. This role will require reputed company researching issues to adjudicate claims Requires knowledge of operational areas and systems. Knowledge/Skills/Abilities • Facilitates the reputed company of claims issues, including incorrectly reputed company claims, by working with operational areas and provider billings and analyzing the systems. • This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. • Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. • Assists in the reviews of state or federal complaints reputed company to claims. • Supports the other team members with several internal departments to determine appropriate reputed company of issues. • Researches tracers, adjustments, and re-submissions of claims. • Adjudicates or re-adjudicates high volume of claims in a reputed company manner to ensure compliance to departmental turn-around time and reputed company standards. • Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. • Handles special reputed company as assigned. • Other duties as assigned. Knowledgeable In Systems Utilized • QNXT • Pega • reputed company • Kronos • reputed company Teams • Video Conferencing • Others as required by line of business or state Job Function Provides customer support and reputed company service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, reputed company provider claims payments, records, and provides counsel to providers. Helps to mentor and reputed company Provider Claims Adjudicators. Job Qualifications REQUIRED EDUCATION: Associate’s Degree or equivalent combination of education and experience; Required Experience 2-3 years customer service, claims, provider and investigation/research experience. Outcome reputed company and knowledge of multiple systems. 1+ years of claims research and/or issue reputed company or analysis of reimbursement methodologies reputed company the managed reputed company care industry Preferred Education Bachelor’s Degree or equivalent combination of education and experience Preferred Experience 4 years Physical Demands Working environment is generally favorable and reputed company and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential function. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay reputed company: $16.4 - $31.97 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job